Ototoxicity May Lead to Reading Difficulties Among Pediatric Patients with Brain Tumors

Children with severe sensorineural hearing loss (SNHL) from brain tumor treatment demonstrated greater reading difficulties compared with those who experienced mild or no hearing loss, according to results published in the Journal of Clinical Oncology.

While highlighting the need for earlier interventions, these findings also point toward the role healthcare professionals can play. “If the medical staff is aware of this risk, they can facilitate audiology appointments , as well as using hearing aids, because we understand what the risks are in terms of academic and reading struggles if those things are not addressed early,” study corresponding author Heather Conklin, PhD, member of the Psychology Department and chief of the Section of Neuropsychology at St. Jude Children’s Research Hospital, said in an interview with Oncology Nursing News.

“They can also identify patients who are greatest risk so those families in particular are prepared,” she added. “In some cases, they can reassure families if their child is at a lower risk for hearing loss, and that is a worry they can take off the list. For example, children who haven’t received platinum-based therapy, who have had cochlear-sparing therapy where they protect the cochlea from radiation therapy, or those who are older — say late school age – those groups are not going to be at high risk for hearing problems that could impact reading.”

In the study, the researchers prospectively gathered, serial, neuropsychological and audiology data for 260 children and young adults aged 3 to 21 years (mean, 9.15 years) — including 196 children with intact hearing or mild to moderate SNHL and 64 children with severe SNHL. Treatment protocol for patients included surgery, risk-adapted craniospinal irradiation (average risk, n = 186; high risk, n = 74), and chemotherapy.

The researchers assessed 8 neurocognitive variables supporting reading, such as phonemics, fluency, and comprehension, and contributory cognitive processes, such as working memory and processing speed.

Children and young adults with severe SNHL performed significantly worse on all variables, except for tasks assessing awareness of sounds and working memory, compared with normal or mild to moderate SNHL (P ≤ .05).

After controlling for age at diagnosis and risk-adapted craniospinal irradiation dose, phonemic skills, phonetic decoding, reading comprehension, and speed of information processing remained significantly lower for children with severe SNHL (P ≤ .05).

While most of the data were not surprising to Conklin, one finding was. “When we looked back at our data more specifically with respect to age of treatment, we learned that patients under 7 were particularly at risk for hearing and reading issues, which gave us some more hints into how we need to target our interventions,” she said.